Course Application for Emergency Medical Services Classes
A "Course Application" is required of individuals seeking to enroll in any of the following:
Financial aid eligibility requires individuals to be accepted to and enrolled in a program of study.
*Notes for form administrators:
File Extensions - Before files can be processed into EX, allowed file extensions must be made available to the Admissions Candidacy Essay Attachment Use Code in the Make File Extension Available for Attachment window.
Attachment Mapping - Before the form will successfully process into EX, mapping will need to be updated for each of the Candidacy Attachment rows to ensure that the ATTACHMENT_CDE values are valid attachment types and are associated with the AD_CANDCY Use Code in the Attachment Type Definition window in EX.
Relationship Mapping - Before the form will successfully process into EX, mapping will need to be updated for each of the Relationship Information rows to ensure that the REL_CDE values are valid relationship codes defined in the Relationship Definition window in EX.
Waiver Codes - The waiver code question has been associated with the Waiver Codes data source. The example is a hard coded data source. In a real-world example, it would be best to store these waiver codes in a custom table.
Payment Profile - The payment profile for this form has been associated with the submit button. The transaction code should be updated to a valid AR_CDE defined in the EX Receipt Code Control window.
Mapping Information - This form contains default mappings for questions existing on the form. Some client-specific values, like Candidacy Stage and Type, may be desired and can be added by modifying the mapping and entering a custom value for the specified column.
Name and Bio Information
Prior Last Names (List all applicable)
Race (Choose one or more)
US State of Residency
Resident of THAT State Since
(Use DOB if born in that state.)
In which academic YEAR would the applicant like to enroll?
In which TERM would the applicant like to enroll?
Credential Being Sought
(Select "non-matriculating" if applicant wishes to take the licensure class(es) without enrolling in the EMS certificate or associate degree program (or any other program of study such as Fire Science or Liberal Studies).
Program of Study (if applicable)
Desired Location To Take Classes:
(EMT classes are not offered at each location each semester.)
Applicant's current level of licensure?
Mailing Address (Line 1)
Mailing Address (Line 2)
Primary Phone #
Mobile Phone #
Confirm Email Address
We will send the applicant an email confirmation receipt of this application as well as a checklist of next steps upon submission (below). Please allow up to 3 business days for initial processing.